Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates

Chiumento, Anna; Rahman, Atıf; Frith, Lucy; Snider, Leslie; Tol, Wietse A.

doi:10.1186/s12992-017-0231-y

Cited by 30 publications

(38 citation statements)

References 56 publications

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“…local consultation), this was not possible due to the unstable security situation in the area. Implementation research in humanitarian settings must, first and foremost, respect the ethical principle of safety towards both participants and the research team, which could not be ensured at the time of the study [61]. However, excluding community members from this process implies that the adaptations made to the PM+ manuals reflect the opinions of professionals and not necessarily the direct perceptions, attitudes and cultural understandings of beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

et al. 2020

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Background: Despite the widely recognised importance of cultural adaptation to increase the effectiveness of psychological interventions, there is little guidance on its process. Developed based on existing theory, we applied a four-step process to culturally adapt a low-intensity psychological intervention for use in humanitarian settings. Methods: The four-step process was applied to adapt a WHO low-intensity psychological intervention (i.e. Problem Management Plus, or PM+) for use with displaced Venezuelans and Colombians in Colombia. First, a rapid desk review was used as an (1) information gathering tool to identify local population characteristics. Next, the results were taken forward for the (2) formulation of adaptation hypotheses, whereby PM+ protocols were screened to identify components for adaptation, drawing on the Ecological Validity Model. Third, the elements flagged for adaptation were taken forward for (3) local consultation to firstly, verify the components identified for adaptation, to identify other areas in need of adaptation, and thirdly, to adapt the intervention protocols. Finally, the adapted intervention protocols were reviewed through (4) external evaluations with local experts. Results: The information gathering phase yielded key information on the socioeconomic aspects of the groups targeted for intervention, the availability and need for mental health and psychosocial support, and existing barriers to accessing care. The adaptation hypotheses phase further identified the need for clearer explanations of key concepts, the need for sensitive topics to match local attitudes (e.g., domestic violence, thoughts of suicide), and the identification of culturally appropriate social supports. Building on these first two phases, local consultation subsequently resulted in revised PM+ protocols. The adapted protocols differed from the original format in their focus on the problems unique to these population groups, the way that psychological distress is expressed in this context, and the inclusion of locally available supports. The results of the external evaluation supported the adaptations made to the protocols.

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Section: Discussionmentioning

confidence: 99%

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

et al. 2020

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“…Given the specific challenges related to conducting research in humanitarian settings, such studies should ideally have the form of randomised pragmatic trials focused on issues such as feasibility and cost-effectiveness [ 53 , 54 ]. This review suggests that the introduction of clozapine as a third step in a treatment protocol could yield significant benefits.…”

Section: Discussionmentioning

confidence: 99%

Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance

Ostuzzi

Barbui

Hanlon

et al. 2017

BMC Med

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BackgroundPopulations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings.MethodsFollowing the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations.ResultsWhen first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions.ConclusionsAdapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0960-z) contains supplementary material, which is available to authorized users.

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“…What ethical guidelines and IRB procedures should be adopted? Should they differ from ethical guidelines in stable settings?38…”

Section: Research Priorities In Humanitarian Crisesmentioning

confidence: 99%

Health research in humanitarian crises: an urgent global imperative

et al. 2019

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Globally, humanitarian crises—such as armed conflict, forced displacement, natural disasters and major disease outbreaks—affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in humanitarian settings. While working in these settings is uniquely challenging, there are effective strategies that can be employed, such as using flexible and adaptive research methodologies, partnering with non-governmental organisations and other humanitarian actors, and devoting greater attention to issues of research ethics, community engagement, local LMIC-based partners, building humanitarian research capacity and collaborating across disciplines.

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Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates

Cited by 30 publications

References 56 publications

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

No implementation without cultural adaptation: a process for culturally adapting low-intensity psychological interventions in humanitarian settings

Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance

Health research in humanitarian crises: an urgent global imperative

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